Provider Demographics
NPI:1770681231
Name:NELSON, SCOTT DEE (DC, LAC, NMD)
Entity Type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:DEE
Last Name:NELSON
Suffix:
Gender:M
Credentials:DC, LAC, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:BLACKFOOT
Mailing Address - State:ID
Mailing Address - Zip Code:83221-2224
Mailing Address - Country:US
Mailing Address - Phone:208-785-6166
Mailing Address - Fax:208-785-1748
Practice Address - Street 1:260 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:BLACKFOOT
Practice Address - State:ID
Practice Address - Zip Code:83221-2224
Practice Address - Country:US
Practice Address - Phone:208-785-6166
Practice Address - Fax:208-785-1748
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDCHIA-415111NX0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedic
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1671276Medicare ID - Type Unspecified